The Impact of Physician Face Mask Use on Endophthalmitis After Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Purpose: To evaluate the effect of physician face mask use on rates and outcomes of postinjection endophthalmitis. Design: Retrospective, comparative cohort study. Methods: SETTING: Single-center. STUDY POPULATION: Eyes receiving intravitreal anti–vascular endothelial growth factor injections from July 1, 2013, to September 1, 2019. INTERVENTION: Cases were divided into “Face Mask” group if face masks were worn by the physician during intravitreal injections or “No Talking” group if no face mask was worn but a no-talking policy was observed during intravitreal injections. MAIN OUTCOME MEASURES: Rate of endophthalmitis, visual acuity, and microbial spectrum. Results: Of 483,622 intravitreal injections administered, 168 out of 453,460 (0.0371%) cases of endophthalmitis occurred in the No Talking group, and 9 out of 30,162 (0.0298%) cases occurred in the Face Mask group (odds ratio, 0.81; 95% confidence interval, 0.41-1.57; P =. 527). Sixteen cases of oral flora–associated endophthalmitis were found in the No Talking group (1 in 28,341 injections), compared to none in the Face Mask group (P =. 302). Mean logMAR visual acuity at presentation in cases that developed culture-positive endophthalmitis was significantly worse in the No Talking group compared to the Face Mask group (17.1 lines lost from baseline acuity vs 13.4 lines lost; P = .031), though no difference was observed at 6 months after treatment (P =. 479). Conclusion: Physician face mask use did not influence the risk of postinjection endophthalmitis compared to a no-talking policy. However, no cases of oral flora–associated endophthalmitis occurred in the Face Mask group. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly attributable to oral flora.